Triage System Helps Colleges Treat Mentally Ill Students

Meredith Was, a senior at the University of Virginia, heads a chapter of the mental health advocacy group Active Minds.

Jenny Gold for NPR

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Originally published on January 8, 2013 3:34 pm

Miranda Dale had her first breakdown during her freshman year at the University of Virginia in Charlottesville. It was 2 a.m. on a Saturday, and she hadn't left her dorm room in days.

"I honestly didn't know what to do," says Dale. "I heard rumors that at a big university you're just a number and you're not going to get through to anyone" at the university counseling center.

But when she called the school's counseling line, someone answered right away. Dale got help getting a prescription for medication, and she was booked for an appointment that Monday. She was eventually diagnosed with bipolar II, a mood disorder that usually requires medication.

Over the past decade, colleges and universities across the country have seen an influx of students like Dale with mental health needs. The stigma of mental illness has started to dissipate, and more students are comfortable seeking help. In addition, teenagers with serious conditions are getting treatment earlier, and so a population of students that previously didn't make it to college now arrives on campus each fall.

The average college counseling center sees about 10 percent of the student body each year.

Some campuses are exploring new systems to help meet the growing demand. At UVA, for example, the counseling center uses a triage system to make sure it is able to see as many students as possible.

When student first call the counseling line, they are given a 20-minute phone consultation with a therapist on their sleeping and eating habits, attendance, substance use, and whether they're having thoughts of self-harm. That's according to psychologist Russ Federman, a former director at the UVA counseling center.

Students in crisis are seen immediately. Another quarter of callers are referred to off-campus therapists right away. Dale was seen only once at the counseling center. After her initial appointment, she was referred to a private therapist off-campus instead.

With the help of the triage system, the UVA counseling center was able to accommodate 9,000 visits last year with only 12 full-time therapists.

Overall, schools are getting better at meeting the mental health needs of their students, says Alison Malmon, president and founder of Active Minds, a mental health advocacy group with chapters on campuses across the country.

"Not everything is great; we would love all students to be able to get all of the unlimited visits they could get on campus," Malmon says.

Recently, anxiety outpaced depression as the No. 1 student complaint on college campuses, according to a survey of college counseling centers. Malmon says that has a lot to do with the current economy.

Meredith Was, who heads up the Active Minds chapter at UVA, says she started to feel the stress of getting a job after graduation during the first semester of her senior year.

Was saw a counselor for just seven sessions, enough to help her deal with the uncertainty of graduation, along with a painful breakup.

Between suicide prevention outreach, free counseling sessions and the triage system, UVA manages to mostly stay ahead of the demand for services.

"We really want students to know it's OK to reach out for help, and there's no shame in having anxiety or depression or anything," says Federman. "It's just part of the human condition."

Over the past decade, colleges and universities have seen an influx of students with mental health needs. That's partly because teenagers have better access to treatment, so those with more serious conditions in high school are now better able to move on to college; plus, more students are comfortable seeking help - all of which is putting increased pressure on mental health services. Jenny Gold visited one school - the University of Virginia, in Charlottesville - to find out how it's managing.

JENNY GOLD, BYLINE: Miranda Dale had her first breakdown during her freshman year at U.Va. It was 2 a.m. on a Saturday, and she hadn't left her dorm room in days.

MIRANDA DALE: I honestly didn't really know what to do. And I was really timid to call because I just - I had heard rumors that, you know, like - you know, at a huge university, you're just a number, you know; and you're not going to actually get through to anyone.

GOLD: But when she called the school's counseling line, someone answered right away; gave her tips on how to get through the night; helped her get a prescription for an anti-anxiety med; and booked her an appointment for Monday. Dale was eventually diagnosed with bipolar type II, a mood disorder that usually requires medication.

DALE: College is already hard enough if you don't have a mental illness. And when you do have something that's, like, binding you down, it can be stressful sometimes.

GOLD: Dale only saw a university counselor that once. They sent her to a private therapist off campus, instead. It wasn't free - like sessions at the counseling center are - but Dale had insurance, and it helped free up space for other students. This triage system is one way U.Va. makes sure they see as many students as possible. Last year, they were able to accommodate 9,000 visits. Psychologist Russ Federman is a counselor at the center.

RUSS FEDERMAN: If a student needs to come in, we have a phone conversation with them, usually about 20 minutes in duration. We assess their current functioning. Are they sleeping? Are they getting to class? What's their substance use like? Are they having thoughts of self-harm?

GOLD: Students in crisis are seen immediately. Another quarter of callers are referred to off-campus therapists right away. But most are squeezed in whenever there's an opening, and seen for about five to 10 sessions. That's what happened to senior Meredith Was. She started feeling depressed this fall, as she thought about graduation.

MEREDITH WAS: There's not a sense of security that having a college degree is going to guarantee you a job. And that is enormously stressful because you don't what's going to happen to you. You don't know how you're going to support yourself; how you're going to float.

GOLD: Recently, anxiety outpaced depression as the number one student complaint on college campuses; something Alison Malmon says has a lot to do with the current economy. Malmon is the president and founder of Active Minds, a mental health advocacy group with chapters on campuses across the country. She says overall, schools are getting better.

ALISON MALMON: Not everything is great. Not everything is a perfect scenario. We would love for all students to be able to get all of the unlimited visits they could get on campus. But with resources being so scarce, and with so many more students seeking out the care that they need, schools have had to adjust.

GOLD: Federman has found another way to help: a bipolar support group for students like Miranda Dale. Bipolar students are at high risk for dropping out, or even attempting suicide. But many end up seeing a psychiatrist just once every six weeks, for medication maintenance.

FEDERMAN: In the life of a university student with bipolar disorder, a lot can change in one, two or three weeks' time. And we find that it's really important to have rapid-response capability.

GOLD: In the bipolar support group, they're able to see the students all at once, every week, instead of tying up individual therapy time. Dale joined the group last year.

DALE: This fall, I remember going into the session. I was in a little bit of a hypomanic up-phase, kind of. And the one girl in the group was - who knew me from last year was like, wait a minute; like, slow down, Miranda; like, I've seen last-year-depressed Miranda, anxious Miranda. Like, something's going on. So it's not just about Dr. Federman. It's mostly like, your peers can have some of the most insight.

GOLD: No matter the issue, Federman says the important thing is for students to seek help, when they need it.

FEDERMAN: We really want students to know that it is OK to reach out for help; and there's no shame in having anxiety or depression, or anything. I mean, it's just part of the human condition.

GOLD: Especially, he says, during the college years. For NPR News, I'm Jenny Gold.